Effects of Virtual Reality-Based Exercise on Balance in Patients With Stroke: A Systematic Review and Meta-analysis.
Jie Shen, Xudong Gu, Yunhai Yao and 7 others
PMID 36170750WHAT IT FOUND
VR-based exercise improved balance by 1.35 points on a 56-point scale in chronic stroke, but showed no significant difference in acute or subacute patients.
Most studies added VR on top of conventional therapy, so the VR-specific effect is unclear.
Key findings
01Pooled across 11 trials, the VR group scored 1.35 points higher on the Berg Balance Scale (0 to 56) than the control group (95% CI 0.85 to 1.86, P < 0.00001). In chronic stroke the difference was 1.35 points (95% CI 0.84 to 1.86, P < 0.0001), but in acute or subacute stroke it was 1.43 points and not significant (95% CI −1.70 to 4.55, P = 0.61).
02Twelve of the fourteen included studies gave VR exercise on top of conventional therapy rather than as a standalone treatment, so the contribution of VR specifically cannot be separated from the combined programme.
03The funnel plot for balance showed an asymmetrical distribution, which the authors interpreted as a high risk of publication bias.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Twelve of the fourteen studies combined VR with conventional therapy, so the effect of VR alone cannot be isolated. The funnel plot was asymmetrical, suggesting publication bias may be inflating the pooled effect. Only three of the fourteen studies included a follow-up measurement, so it is unknown whether the gains persist. Participants had to be able to walk 10 meters or stand for 30 minutes, so the findings do not apply to more severely affected stroke patients. Five of the fourteen studies had an unclear risk of bias rating, and the GRADE certainty ranged from moderate to very low across outcomes. The VR protocols varied widely in frequency, duration, and type of game, making it hard to identify which features drive the effect.
Declared interests
No conflicts of interest were reported by the authors.
The easy way to misread this
Do not read the 1.35-point balance improvement as the effect of VR alone. Twelve of the fourteen studies added VR on top of conventional therapy, so the contribution of VR specifically cannot be separated. In acute or subacute stroke, the balance difference was not significant (P = 0.61), so the positive overall result is driven by the chronic-stroke subgroup.
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